ARTICLE

Falls, Mental Health and Learning Disability

Please don’t ignore movement

Around 1 in 9 working-age adults with learning disability and mental health difficulties experienced a fall or fracture requiring emergency or hospital care

Falls prevention in mental health and learning disability services deserves much more attention.

A new 2026 Scientific Reports study examined 32,410 adults aged 18 to 65 receiving care within a large NHS mental health and learning disability trust.

Across the whole cohort, 2.07% experienced a fall or fracture that resulted in emergency department attendance or hospitalisation within the following 12 months.

But the overall figure hides an important disparity:

• Whole cohort: 2.07%
• Mental health only: 2.24%
• Any mental health difficulty: 2.49%
• Learning disability: 9.20%
• Learning disability plus mental health difficulties: 11.18%

That final figure is around 1 in every 9 people in just one year.

The study defined its mental health group through recorded depression, general mental health difficulties, self-harm, severe mental illness or stress. Learning disability was identified separately through diagnostic records.

There is another finding we should not ignore

The electronic falls model substantially underestimated what was happening for adults with learning disabilities.

Before recalibration, the number of observed falls or fractures in the learning disability groups was around 5.7 to 5.9 times the number predicted.

Even after recalibration improved the overall probability estimates, the model remained less able to distinguish which individual people with learning disabilities were at greater risk. The AUC was 0.777 for the whole population, 0.707 for people with any learning disability, and 0.696 for the learning disability-only group.

That raises an important question.

What might our risk assessments and electronic records not be seeing?

The eFalls model contains a considerable amount of useful information. Predictors include medication count and previous falls, as well as numerous physical health and functional variables.

Within this working age population, people who subsequently fell were more likely to have recorded difficulties or conditions, including:

• dizziness
• hypotension or syncope
• seizures
• mobility difficulties
• weakness
• peripheral neuropathy
• visual impairment
• hearing impairment
• sleep problems and fatigue
• musculoskeletal and back problems
• dressing and grooming difficulties
• washing and bathing difficulties
• meal preparation difficulties
• medication management difficulties
• urinary and faecal incontinence
• cognitive or memory concerns
• social vulnerability
• requirement for care
• previous falls.

These things matter.

But an electronic record cannot easily describe the moment when somebody becomes unsteady.

It may be known that somebody has mobility difficulties. It may not be known that they are fairly steady walking forwards, but they become noticeably unstable when they turn their head.

It may be known that somebody takes several medicines. It may not capture the fact that their movement changes at a specific point after being taken.

It may record visual impairment. It may not describe what happens when the lights are dimmed.

And it almost certainly cannot capture everything a family member or support worker has noticed over the years about how that Person moves.

That is where observation and shared clinical reasoning matter.

Movement relies on sensory information

There is an important distinction here.

Sensory integration is a neurological and physiological process. Our nervous systems continually receive information from our body and surroundings. That information has to be registered, discriminated, organised and integrated so that we can understand what is happening and respond effectively.

Vestibular information contributes information about gravity, acceleration and movement of the head.

Proprioceptive information contributes to our awareness of body position, movement and force.

Tactile information provides information about pressure, contact and where our body meets objects and surfaces.

Vision works alongside these systems.

The nervous system continually brings information from different sensory systems together to support postural control and effective movement. Lane and colleagues reviewed Ayres’ core theoretical propositions alongside contemporary neuroscience, including vestibular, proprioceptive and tactile processing and their relationships with ocular control, posture, bilateral integration and praxis.

Sensory integration is not the same thing as Ayres Sensory Integration® intervention

A. Jean Ayres developed a particular theoretical framework for understanding sensory integration and its relationship with movement, praxis, learning and participation.

Ayres Sensory Integration® intervention was developed from that body of work, but the intervention is something much more specific.

ASI intervention is a specialist occupational therapy approach with defined structural and process elements and an established fidelity measure. Appropriate specialist education and competence are therefore required to assess and deliver the intervention.

Understanding that sensory information contributes to human movement is not the same as claiming to deliver Ayres Sensory Integration® intervention.

That distinction is important.

Sensory aware practice belongs much more widely.

A physiotherapist can observe changes in postural control, gait and balance.
A nurse may notice that someone becomes unsteady after medication, with poor sleep, or during personal care.
A paramedic may see exactly how somebody is moving within the environment where repeated falls occur.
A support worker may notice that someone becomes less steady when rushed or when several things are happening around them.
Paid carers and families may hold years of knowledge about how somebody moves and what makes movement easier or harder.
An occupational therapist or physiotherapist can bring together the Person, their sensorimotor presentation, occupation or postural control and mobility, the environment, their routines, and participation.

None of those people needs to claim that they are “doing ASI” to recognise that sensory input matters – but they are using knowledge about sensory integration as a neurological process reliant on the senses, unique anatomy and physiology and how these underpin and are foundational to balance and movement for participation.

What does the wider research tell us?

The new eFalls paper did not assess vestibular, proprioceptive or tactile processing. We therefore cannot say that differences in sensory integration caused the falls identified in this study.

But other research gives us very good reasons not to ignore these systems.

Vestibular function and learning disability

Leyssens and colleagues investigated vestibular function in adults with intellectual disabilities participating in the Special Olympics. The study identified substantially more abnormal vestibular findings within the intellectual disability group than in controls. This included differences in cervical vestibular evoked myogenic potentials and video Head Impulse Test responses. It was a relatively small and selected sample, so these findings should not be treated as prevalence estimates for every adult with a learning disability.

The same research group later studied 30 adults with intellectual disabilities and 25 controls. Adults with intellectual disabilities demonstrated poorer performance on several postural balance tasks, and the researchers concluded that peripheral sensory difficulties contributed significantly to the balance problems observed.

Proprioception and balance

A 2025 randomised controlled study examined a specific proprioceptive training programme in adults with mild-to-moderate intellectual disability. Participants receiving the programme demonstrated improvements in static balance measures.

This study did not establish that proprioceptive intervention prevents falls, so we should not make that leap. It does, however, demonstrate that postural control in adults with intellectual disability can respond to proprioceptive-focused movement experiences.

Mental health and sensory organisation for balance

Teng and colleagues studied 29 people with schizophrenia and 32 controls under increasingly challenging sensory conditions.

People with schizophrenia demonstrated significantly greater overall postural sway. Difficulties became particularly apparent when somatosensory information was unreliable and visual information was removed or conflicting. Participants with schizophrenia also fell significantly more often during the most challenging conditions.

This does not mean everyone experiencing schizophrenia has a vestibular disorder. The researchers themselves found that some sensory ratios did not differ significantly between groups.

It shows that postural control can become particularly vulnerable when the nervous system must manage uncertain or conflicting sensory information.

Research has also identified poorer tactile discrimination in people with schizophrenia compared with controls, again reminding us that sensory perception in serious mental health presentations is not simply about vision or hearing.

Registration and perception matter too

The presence of sensory information does not automatically mean that the nervous system is using it effectively.

We can remain curious about registration:

Did the person sufficiently notice the relevant sensory information?

And about perception and discrimination:

Could they accurately identify what was happening, where their body was, how much force was involved, which direction they were moving or how quickly something was changing?

Consider standing from a chair.

Vestibular information changes as the head moves relative to gravity. Proprioceptive information changes as muscles contract and joints move. Tactile information changes as weight transfers from the chair towards the feet. Vision contributes information about the surrounding space.

The nervous system has to organise that changing information rapidly enough to stand, stabilise and move.

Now consider the same occupation at 2 am.

The lights are low.
The person has recently taken medication.
They urgently need the toilet.
The ward is unfamiliar.
They are tired.
Someone is encouraging them to hurry.

The movement may appear identical on a care plan. The demands on the person are not.

That is why falls are not simply located inside people.

They happen within contexts.

Falls prevention must not become movement prevention

Reducing movement can look like the safest response to somebody who falls.

Sometimes, a temporary restriction is necessary while an acute health or safety concern is being assessed.

But movement itself matters for physical health, strength, postural control, confidence, experience, occupational competence and participation.

NICE recognises individualised programmes involving balance, coordination and strength as part of falls prevention for populations within NG249, alongside medication review and environmental approaches. The guideline also highlights the importance of tailoring interventions to the individual person and context.

Our aim should therefore not simply be:

“How can we stop this person from falling?”

We also need to ask:

“How can we support this person to move and participate as safely and meaningfully as possible?”

Recommended Products

Loading recommended products…